UNMC

Membership Registration for Nebraska Physiological Society Meeting

The registration for the meeting includes 2017 membership in the Nebraska Physiological Society, breakfast, lunch and break snacks at the meeting.

DEADLINE: October 2, 2017

* Required information

Name*
Title*
School*
Address*
E-mail*
Phone*

Registration:*

Professional Status Member $50.00
Postdocs and Graduate students $25.00
Undergraduate students $15.00

FRIDAY NIGHT SOCIAL - October 27, 2017
The Friday Night Social will be held at Dudley’s Pizza and Tavern.  2110 S. 67th Street, Omaha, NE - In Aksarben Village. The social will consist of heavy appetizers and two drink tickets (either alcoholic or non-alcoholic).  A bar tab can be started afterwards.  Free parking is available.

Cost for Friday night social:
Free to NPS Members - cost is included in your registration
Guest - $25.00
I will attend the Friday night social Yes No
I will bring a guest to the Friday night social Yes No

Please answer the following questions for the American Physiological Society:
Did you attend the APS Experimental Biology Meeting in 2017? Yes No
Are you planning on attending the APS Experimental Biology Meeting in 2018? Yes No

See the NPS website for more information.

NOTICE: This Membership Registration Form may be submitted electronically or mailed to the address below. In either case, mail your membership/registration dues to the address below:

Cindy Norton CAP-OM
Executive Director
Nebraska Physiological Society
University of Nebraska Medical Center
Department of Cellular and Integrative Physiology
985850 Nebraska Medical Center
Omaha, NE 68198-5850
Tel:402-559-4426
FAX: 402-559-4438
Email: nps@unmc.edu

Type the text from the image into the space below.

Form last updated 08/14/17

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